Kidney Center of South Louisiana, AMC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

KIDNEY CENTER OF SOUTH LOUISIANA, AMC

Practice address

604 N. Acadia Rd.
Suite 405
Thibodaux, LA 70301

Phone

(985) 446-0871

Fax

(985) 446-0874

NPI assigned

May 10, 2007

Last updated

Sep 12, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

KIDNEY CENTER OF SOUTH LOUISIANA, AMCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vicki C. Ledet

Title

Practice Administrator

Phone

(985) 446-0871

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Kidney Center of South

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EFEIBA

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Kevin Modisette, M.D.

  • Nephrology Physician
  • Thibodaux, LA
  • NPI 1063413995
  Medicare reassignment Care Compare group NPD
• Allen W. Vander, M.D.

  • Nephrology Physician
  • Thibodaux, LA
  • NPI 1669473054
  Medicare reassignment Care Compare group NPD
• Gabrielle Julie Wurzlow, NP

  • Family Nurse Practitioner
  • Thibodaux, LA
  • NPI 1467861609
  Medicare reassignment Care Compare group NPD
• Penny Rush Rodrigue, FNP-C

  • Family Nurse Practitioner
  • Thibodaux, LA
  • NPI 1457979684
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1386858918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 N. ACADIA RD.",
            "address_2": "SUITE 405",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-0871",
            "fax_number": "985-446-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N. ACADIA RD.",
            "address_2": "SUITE 405",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-0871",
            "fax_number": "985-446-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CENTER OF SOUTH LOUISIANA, AMC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDNEY CENTER OF SOUTH LOUISIANA, AMC",
        "enumeration_date": "2007-05-10",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "LEDET",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "985-446-0871",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH9035",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• KCS Transportation LLC
• Ebara T Keeling, BA
• Ryan Michael Kelley, PMHNP-BC
• Carolyn Kennedy
• David R Kesterson, PA-C
• Christopher Kimble, CRNA
• Elisabeth King, BA
• Lashawn King, BA
• Laney Toups Kirk, M.S., CCC-SLP
• Brenda B Klazynski, LCSW

• Nephrology Physician in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Nephrology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.